A unique method of donor pool expansion is the retransplantation of livers from recipients who die (brain-death). The hesitancy to reuse livers is in part related to a lack of outcome data, particularly in light of the scrutiny of outcomes of liver transplantation. From 2007, we implemented the policy of reusing liver allografts and here we extrapolate from our experience the potential for liver procurement. Of our 3 cases all first recipients had fulminant hepatic failure (FHF), two progressed to brain death early and the third died 4.5 years later. The first two livers were retransplanted in patients with hepatocellular carcinoma and the third patient had autoimmune hepatitis. They survived for 34, 64(both still alive) and 14 months respectively and no instance of recipient outcome was attributed to graft dysfunction. The initial rise in liver enzymes was less in second recipient in comparison to the first and may indicate less reperfusion injury the second time. Reviewing the UNOS report of 2010, in the 5 years up to and including 2008 a median 355 patients with acute hepatic necrosis were transplanted; adjusted 3 month patient survival rate of 90.6% in 2007-2008. We estimate around 34 organs were potentially available for transplantation that year from this population alone. The reuse of liver allografts and potentially other organs should be encouraged in the event of brain-death of a liver transplant recipient.

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